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WHO KILLED DAVID KOSCHMAN? | A WATCHDOGS INVESTIGATION

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THELAST DAYSOF DAVID KOSCHMAN


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ONE PUNCH. Three skull fractures. Two brain operations. Two heart surgeries. Twelve days fighting for his life after he was hit by Mayor Daleys nephew. Newly released hospital records shed light on . . .

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22A | CHICAGO SUN-TIMES | SUNDAY, MAY 1, 2011

WHO KILLED DAVID KOSCHMAN? | A WATCHDOGS INVESTIGATION

THE LAST DAYS OF DAVID KOSCHMAN


BY CHRIS FUSCO AND TIM NOVAK

ManhitbyDaleynephewdiedaftercardiacarrest,4surgeriesin12days
is skull fractured in three places, his brain dangerously swollen, David Koschman was loaded onto a backboard by Chicago Fire Department paramedics and rushed to the emergency room at Northwestern Memorial Hospital. It was 10 minutes to four in the morning on April 25, 2004 about half an hour after Koschman had been punched in the face by Richard J. R.J. Vanecko, a nephew of Mayor Daley and William Daley, President Obamas chief of staff, in a drunken confrontation on Division Street at Dearborn. Koschman, whod been out drinking with friends, fell backward and hit his head on the street. The 21-year-old from Mount Prospect was moaning and thrashing when he got to the emergency room, newly obtained records show. He would never regain consciousness and never leave Northwestern. In his 12 days there, doctors would perform two brain operations and two heart surgeries including a coronary bypass. He died at 11:26 a.m. on May 6, 2004, six minutes after doctors, acting with the permission of his mother, Nanci Koschman, took him off life support. His final days and the details of his medical treatment are described in 1,338 pages of records his mother obtained from Northwestern Memorial. The records show Koschman was in grave condition from the moment his head struck the pavement. Less than three hours later, surgeons were drilling a hole in his skull and inserting a device to monitor the pressure on his brain. Despite the severity of Kos-

Staff Reporters

Richard R.J. Vanecko


tors there had been expecting him to be alert and oriented but instead found him to be minimally responsive, according to the medical records. Soon after he arrived, Koschman underwent the first of 11 CT scans of his brain; had a breathing tube inserted in his throat, and was catheterized in preparation for surgery. A toxicology test about two hours after he was punched showed Koschman had a blood-alcohol level of .193 percent more than twice the level at which he could have been charged with DUI if he had been driving. The hospital records show Koschman was in a fight this evening. Hit to mouth per friends. Koschman was assaulted, though the circumstances surrounding the assault are unclear, wrote his doctor, Joshua M. Rosenow, a neurosurgeon. Koschmans only visible injury, according to the hospital records, was a large bruise on the back of his head. A CT scan showed he had three skull fractures and a subdural hematoma meaning his brain had been bleeding, a potentially life-threatening condition and diffuse cerebral edema meaning his brain was swelling. At 5:10 a.m., doctors began

David Koschman was punched on Division Street between State and Dearborn on April 25, 2004. | KEITH HALE~SUN-TIMES
1 without seeking criminal charges. Going over the medical records was painful for Nanci Koschman. I really would like R.J. to read them, to realize what that one simple punch did to my son, she says. Nanci Koschman has recently been contacted by city of Chicago Inspector General Joseph Ferguson, who is investigating the police departments handling of the case. Ferguson declined to comment. Vaneckos father Dr. Robert M. Vanecko, a brother-in-law of the mayor is a cardiothoracic surgeon and former chief of staff at Northwestern. He didnt treat Koschman, according to the hospital records. Among those who did was Dr. Patrick M. McCarthy, who succeeded Vanecko as head of cardiothoracic surgery. Vanecko didnt respond to an interview request. McCarthy and other hospital officials declined to discuss Koschmans case.

prepping him for neurosurgery. Within the hour, they drilled into his skull and screwed in a bolt to help monitor pressure on his brain. By 7:15 a.m., Koschman was sent to the hospitals Neurological Surgical Intensive Care Unit. Patient is sedated, Rosenow wrote. He is in a cervical collar. He does not open his eyes. He does not follow commands. He will localize painful stimuli with his left upper extremity. He will withdraw his right upper extremity. He will move both his legs symmetrically to stimulation. Koschman also was occasionally moving spontaneously, so doctors restrained him to keep him from dislodging the lines and tubes helping keep him alive, hooking him to the ventilator, brain monitor and IV.

Why, why, why?


Thats how Nanci Koschman found her only son when she got to the hospital around noon on April 25, 2004, a Sunday, about an hour after a friend of her son reached her at home in Mount Prospect to tell her David had been hurt. He was in the hospital, she was told, unconscious, and not getting ready for the Cubs game hed been planning to go to. All I was just doing was sitting, looking at this young man in the bed, going, Why, why, why? Nanci Koschman says. He just went down to have a good time and missed the Cubs game, and I dont know whats going to happen. The police called that afternoon. Nanci Koschman told a detective her son would be sedated for at least five days. And, at least at first, there were hopeful signs. Two days after Koschman got to the hospital, doctors noted that Koschman was

Dr. Patrick M. McCarthy

Dr. Joshua M. Rosenow

chmans injuries, the Chicago Police Department which initially classified the case as a battery halted its investigation that same day, and detectives didnt try to talk with most of the witnesses until after Koschman died. The Cook County Medical Examiners Office called Koschmans death a homicide. The case remained dormant for seven years, until Jan. 4, when the Chicago Sun-Times requested records of the investigation. Top Chicago Police Department brass then ordered a new investigation, and detectives determined that the 6-foot-3, 230-pound Vanecko punched the 5-foot-5, 140-pound Koschman but did so in self-defense. They closed the case March

Does not open his eyes


When paramedics rushed Koschman to the hospital, doc-

SUNDAY, MAY 1, 2011 | CHICAGO SUN-TIMES | 23A

Copy goes here and so on

Vaneckos father long a top surgeon at hospital that treated Koschman


Northwestern Memorial Hospital where David Koschman was taken after being punched by Mayor Daleys nephew Richard J. R.J. Vanecko was the closest trauma center. Its also where Vaneckos father, Dr. Robert M. Vanecko, has been a leading surgeon for decades. Vanecko didnt treat Koschman, according to newly obtained hospital records. Vanecko, who has been at Northwestern since 1970, is a former chief of staff there, from 1994 to 1996. He was interim chief of cardiothoracic surgery between July 1, 2003, and April 1, 2004, when he was succeeded by Dr. Patrick M. McCarthy, who performed coronary-bypass Dr. Robert M. surgery on Koschman on April 29, 2004. Vanecko Vanecko, 75, and McCarthy, 55, are the sons of doctors who worked together for decades at Little Company of Mary Hospital in Evergreen Park. Vanecko graduated from Georgetown University in 1957 and from Northwestern University Medical School in 1961. He was a resident surgeon at Cook County Hospital when he married then-Mayor Richard J. Daleys daughter, Mary Carol, in 1964. During the Vietnam War, Vanecko served in the Air Force as chief of surgical services at a base near Miami. He returned to Chicago to complete his residency in cardiothoracic surgery at Hines VA Hospital in 1970. He also spent 21 years as a medical adviser for a Chicago city pension fund, examining injured city workers to verify their disability claims. Vanecko remains on staff at Northwesterns Feinberg School of Medicine, where he is a professor of cardiothoracic surgery.

DAVID KOSCHMANS INJURIES


In this report, written hours after paramedics rushed David Koschman to Northwestern Memorial Hospital, his neurosurgeon, Dr. Joshua M. Rosenow, describes Koschmans grave condition.
able to hear and tries to open eyes, squeezes bilaterally with fingers, moves arms, legs, feet, toes on command. The next day, they decided to see how he would do without being sedated, taking him off sedation for a brief period of time, according to a nurses note. Koschman was trying to follow commands, the nurse noted. Opens eyes to command. Moves extremities. But the nurse also noted: When off sedation, is very restless. . . . Patient placed back on propofol, a sedation drug. Nanci Koschman recalls: He started to come to, and I just said, David, Im here. Do you know Im here? And he shook his head, but he couldnt open his eyes. And then everything went downhill from there. He never came back. His fifth day in the hospital, April 29, 2004, started with a pair of CT scans at midnight: A head CT showed pressure on his brain increasing; a chest CT showed a possible blood clot in his lungs. Before that day was over, he would have two emergency heart surgeries. The first, at 8 a.m., was an 11-minute operation in which surgeons inserted a clot-busting filter in the inferior vena cava, the large vein that returns blood from the lower body to the heart. Two hours later, Koschman went into cardiac arrest. He was resuscitated, but afterward he developed abnormal heart rhythms and a condition called rhabdomyolysis, which was damaging his kidneys, the records show. At 6:30 that night, Koschman was taken into surgery for the coronary bypass by McCarthy. In a post-surgical report, McCarthy described Koschman as an unfortunate 21-year-old man who had been the victim of trauma

and who, in addition to his neurological problems, began developing numerous other complications. More than 30 family members and friends showed up at the hospital before Koschman went to the operating room. They had us all say goodbye to him because they didnt think hed come out of it, Nanci Koschman says, but, He came through heart surgery. Two days later, I got a call. They said they were removing parts of his brain. Koschmans brain had continued to swell, measured in part by the increasing size of his pupils, which were unequal in diameter and did not respond to light. By the morning of May 3, 2004, his ninth day in the hospital, the pressure on his brain had tripled. A doctors note said he was very grave. That morning, surgeons performed a lobectomy: They removed a flap of bone from Koschmans skull so they could remove part of his brain and also drained a blood clot.

After surgery, Koschman who had gained about 40 pounds from fluid build-up during his hospital stay remained in a coma. At one point, he had eight IVs and was on more than a dozen medications. A day after the lobectomy, his temperature spiked from 101.8 degrees to 111.8 degrees in less than an hour. Nurses gave him an ice bath and cooling blanket. His temperature dropped to about 100. On May 6, 2004, Koschmans 12th day in the hospital, doctors noted he was developing renal failure. After talking with Nanci Koschman, Rosenow signed a do not resuscitate order, and David Koschman was taken off all of the life-support devices. Six minutes later, he died. Making the decision to turn off life support was the toughest decision any mother should have to make, Nanci Koschman says. I would like R.J. to understand that the punch killed my son, maybe not right away, but gradually, which I had to watch.